- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.16 / $264.08 / $540.25
| Facility | | $131.16 | $264.08 | $540.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.15 / $131.16 / $159.77
| Professional | | $131.15 | $131.16 | $159.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.96 / $230.29 / $419.71
| Facility | | $142.96 | $230.29 | $419.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $131.16 / $131.16
| Professional | | $131.16 | $131.16 | $131.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.73 / $123.73 / $173.23
| Facility | | $123.73 | $123.73 | $173.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $131.16 / $131.16
| Professional | | $131.16 | $131.16 | $131.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.04 / $177.26 / $377.36
| Facility | | $132.04 | $177.26 | $377.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.37 / $144.27 / $215.10
| Professional | | $98.37 | $144.27 | $215.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $131.16 / $131.16
| Professional | | $131.16 | $131.16 | $131.16 |